The Patient-Centered Medical Home (PCMH) model involves complete primary care practice redesign with the ultimate goal of improving the quality of patient care and at reduced cost. Detailed information regarding the practice level costs of performing transformative activities is needed to help the growing number of practices and practice organizations as they navigate this process. The overall objective of this study is to examine the direct and indirect practice level costs of supporting care transformation by evaluating costs within five small to medium sized primary care practices that have demonstrated improved clinical outcomes in diabetes or asthma measures within the North Carolina Practice Support Program and have also received PCMH recognition status by the National Committee for Quality Assurance. The aims of the study are to 1) analyze the overall costs of transformative activities that are supported by the NC AHEC practice support program that include the original and ongoing quality improvement activities defined by the NC IPIP program as well as the activities performed to qualify these practices as Medical homes by NCQA and 2) to disseminate our costs analysis results to stakeholders in health care and care transformation. This project will enhance understanding of the practice level costs of transformation which will be of value to policy makers, quality improvement organizations and primary care physicians. It is expected that products of this work could help practices streamline and anticipate costs when embarking on work related to practice transformation.